Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, Columbus, Ohio, USA.
Partners For Kids, Columbus, Ohio, USA.
J Rural Health. 2022 Mar;38(2):420-426. doi: 10.1111/jrh.12587. Epub 2021 May 12.
To contrast trends in rural and urban pediatric home health care use among Medicaid enrollees.
Medicaid administrative claims data were used to assess differences in home health care use for child members in a large pediatric accountable care organization (ACO) in Ohio. Descriptive statistics assessed rural and urban differences in health care use over a 10-year period between 2010 and 2019.
Pediatric home health care use increased markedly in the low-income (CFC) and disabled (ABD) Medicaid categories. Over the past 10 years, CFC-enrolled children from urban communities have seen more home health visits, fewer emergency department (ED) visits, and more well child visits compared to rural CFC-enrolled children. Children enrolled due to disabilities in urban communities have also seen more home health visit use but fewer preventive care visits than their rural counterparts.
Within a pediatric ACO, rural home health care use has remained relatively stagnant over a 10-year period, a stark contrast to increases in home health care use among comparable urban populations. There are likely multiple explanations for these differences, including overuse in urban communities, lack of access in rural communities, and changes to home health reimbursement. More can be done to improve rural home health access. Such improvement will likely necessitate large-scale changes to home health care delivery, workforce, and financing. Improvements should be evaluated for return-on-investment not only in terms of direct costs, that is, reduced inpatient or ED costs, but also in terms of patient and family quality-of-life or key indicators of child well-being such as educational attainment.
对比医疗补助计划（Medicaid）参保者在农村和城市的儿科家庭保健服务使用方面的趋势。
利用医疗补助管理索赔数据，评估俄亥俄州一个大型儿科管理式医疗组织（ACO）中儿童成员家庭保健服务使用方面的农村和城市差异。描述性统计评估了 2010 年至 2019 年期间，10 年来低收入（CFC）和残疾（ABD）医疗补助类别的医疗保健使用差异。
儿科家庭保健服务在低收入（CFC）和残疾（ABD）医疗补助类别中显著增加。在过去的 10 年中，与农村 CFC 参保儿童相比，城市社区的 CFC 参保儿童家庭健康访问次数更多，急诊室（ED）就诊次数更少，儿童健康检查次数更多。城市社区因残疾而参保的儿童也更多地使用家庭健康访视服务，但预防性护理就诊次数比农村同龄人少。
在儿科 ACO 中，农村家庭保健服务在过去 10 年中相对停滞不前，这与可比城市人群家庭保健服务使用的增加形成鲜明对比。造成这些差异的原因可能有很多，包括城市社区的过度使用、农村社区的缺乏获取途径，以及家庭健康报销的变化。可以采取更多措施来改善农村家庭健康服务的获取。这种改进可能需要对家庭保健服务的提供、劳动力和融资进行大规模改革。改进措施不仅应评估直接成本（即减少住院或 ED 成本）的投资回报，还应评估患者和家庭的生活质量或儿童福祉的关键指标，例如教育程度。
